The mission of Prognosis is to explore the nexus at which healthcare policy meets healthcare practice and how one affects the other. This blog makes readers more aware of the innovations taking place in healthcare delivery, financing and technology and the types of public policies that will encourage further progress.

Healthcare In Focus is a public education initiative of the HLC, created to promote a constructive dialogue about the state and future of American healthcare.

John Borsos’s Press Club remarks could be boiled down to these points:

• There is no evidence workplace wellness programs improve health or save money.
• Wellness incentives are unfair to those who don’t choose to try to achieve them.
• Wellness programs are an invasion of personal privacy.
• What America really needs is a single-payer healthcare system.

What America actually needs is a discussion about wellness and disease prevention that relies more on facts than hyperbole. Employers throughout the country have, in fact, developed firm evidence that wellness initiatives are bringing greater health to employees and reducing healthcare costs. You can find specific metrics on many of these successes in a compendium we have published, The Future Is Here.

On the topic of how to make wellness programs work in the workplace setting, I urge you to read the post by Colin Watts of Weight Watchers below. He offers an insightful discussion on the relative efficacy of carrots versus sticks in these programs.

And, as to privacy, as Kaiser Permanente, CVS Caremark and others have pointed out ad nauseum, wellness profiles of employees are collected and viewed in the aggregate. Individual privacy is constantly respected and protected.

The fact is, we are facing a significant, disturbing escalation in chronic illnesses like diabetes, heart disease and pulmonary illness that will affect both the health and finances of the U.S. population, not to mention the sustainability of our healthcare system. We need bold action to address this growing problem, and that action cannot exclude the eight or more hours each day that millions of Americans spend at their workplace.

(The following post was authored by Colin Watts, President of Weight Watchers Health Solutions. Weight Watchers is a member of the Healthcare Leadership Council.)

In our conversations with employers, we’re often asked: What works better when it comes to employee wellness programs – penalties or incentives? In other words, should we use a carrot, a stick or some combination? It’s a great question and one we’re studying closely through our research. One interesting example is a program Weight Watchers is supporting for the Oregon Educators Benefit Board (OEBB) and Oregon Public Employees’ Benefit Board (PEBB), which provide health insurance coverage to state teachers and public employees.

In 2009, obesity-related ailments were driving health care costs for the State of Oregon public employees and educators to the tune of nearly $1.6 billion. At the same time, in partnership with OEBB and PEBB’s health plan providers (Providence, Kaiser Permanente and ModaHealth,) Weight Watchers – both meetings and online tools – was offered to all of OEBB and PEBB’s covered lives. If a participating member attended 75 percent of their Weight Watchers meetings, the cost was completely covered.

That year, PEBB decided to introduce financial incentives into their benefit design, which included completion of a confidential health risk assessment (HRA) and participation in at least two resulting action steps, which could include a weight management program.

During the first year of the program, they charged employees a penalty of $17.50 per month if they failed to take a baseline health risk assessment and follow through with lifestyle recommendations. That first year, 70 percent of employees completed their assessment and took action.

The following year, in 2010, the penalty was switched to a $17.50 per month reward for participation and a $100 higher deductible per person for those not participating. This action resulted in a 7 point increase in the percentage of employees completing the wellness recommendations and action steps.

This example would suggest that both penalties and rewards impact employee participation. That said, it would also indicate that rewards lead to better participation than penalties. While participation is highly linked to outcomes in several weight management studies, it has not been rigorously evaluated with the inclusion of a mandatory penalties/rewards program.

While not definitive, the results in Oregon are promising. Between 2009 and 2012, a time when rates of obesity were increasing among the State’s general population, obesity rates decreased among state employees and educators from 28 percent to 22 percent. Given the PEBB experience, OEBB started a similar program in 2013.

“These results show that a well-designed wellness program coupled with financial incentives that prompt and reward healthy behaviors can work,” said Joan M. Kapowich, administrator at PEBB. “Setting up programs that help employees succeed in changing their habits and rewarding them for doing so was really key for us. It has demonstrated success in reducing our cost trends and improving the health status of our members.”

The October jobs report from the Bureau of Labor Statistics showed unemployment inching up from 7.2 percent in the September report to 7.3 percent today. That, however, wasn’t the most significant concern emerging from those numbers.

The healthcare industry added about 15,000 jobs in October, slightly lower than 17,000 jobs-per-month average we’ve seen so far this year and significantly below the average monthly increase of 27,000 in 2012.

Yes, healthcare is still proving to be a vital job-creating engine for our nation’s economy, but the concern at hand is whether job growth in the various health professions will keep pace with escalating demands caused by Affordable Care Act health exchange enrollments, Medicaid expansion and the aging of the U.S. population.

There has been a great deal written about our society’s increasing need for doctors as health services utilization stays on an upward trend, but it’s not just physicians. The current and potential healthcare workforce shortages extend to all parts of the workforce, from nurses to pharmacists to researchers.

The multi-sector membership of the Healthcare Leadership Council is actively engaged on this issue.

During meetings with members of Congress and congressional candidates, HLC has consistently emphasized workforce shortages and the corresponding need for more interest and participation in science, technology, engineering and math (STEM) education; realignment of incentives to encourage more integrated, coordinated team care; and adequate payments for hospitals, clinics, doctors, laboratories and other providers.

This month, we will be bringing together representatives from our member companies and organizations for in-depth discussions on how multiple sectors can bring their particular insights to this challenge and to focus on the public policy steps that could help alleviate the healthcare workforce shortages – shortages that are likely to be exacerbated in the very immediate future.